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. 2020 May-Jun;9(3):175-179.
doi: 10.4103/eus.eus_3_20.

EUS-guided pancreatic drainage: A steep learning curve

Amy Tyberg  1 , Vimal Bodiwala  1 , Prashant Kedia  2 , Paul R Tarnasky  2 , Muhammad Ali Khan  3 , Aleksey Novikov  4 , Monica Gaidhane  1 , Jose Celso Ardengh  5 , Michel Kahaleh  1
Affiliations

EUS-guided pancreatic drainage: A steep learning curve

Amy Tyberg et al. Endosc Ultrasound. 2020 May-Jun.

Abstract

Background and objective: EUS-guided pancreatic drainage (EUS-PD) is an efficacious, acceptable risk option for patients with pancreatic duct obstruction who fail conventional ERCP. The aim of this study was to define the learning curve (LC) for EUS-PD.

Methods: Consecutive patients undergoing EUS-PD by a single operator were included from a dedicated registry. Demographics, procedural info, adverse events, and follow-up data were collected. Nonlinear regression and cumulative sum (CUSUM) analyses were conducted for the LC.

Results: Fifty-six patients were included (54% of male, with a mean age of 58 years). Technical success was achieved in 47 patients (84%). Stent placement was antegrade in 36 patients (77%) and retrograde in 11 (23%). Clinical success was achieved in 46/47 (98%) patients who achieved technical success. Adverse events were seen in 13 patients (6 of whom did not achieve technical success) and included bleeding requiring embolization (n = 5), bleeding treated with clips peri-procedurally (n = 1), pancreatitis (n = 5), and a pancreatic fluid collection drained via EUS-drainage (n = 2). The median procedural time was 80 min (range 49-159 min). The CUSUM chart showed that 80-min procedural time was achieved at the 27th procedure. Durations further reduced 40th procedure onward, reaching a plateau indicating proficiency (nonlinear regression P < 0.0001).

Conclusion: Endoscopists experienced in EUS-PD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 80 min and a learning rate of 27 cases. Continued improvement is demonstrated with additional experience, with plateau indicating mastery suggested at the 40th case. EUS-PD is probably one of the hardest therapeutic endosonographic procedures to learn.

Keywords: EUS-guided pancreatic drainage; pancreatic stricture; pancreatico-jejunostomy; pancreaticogastrostomy; therapeutic EUS.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Nonlinear regression curve of EUS-PD between procedural time and number of cases
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